My daughter, Janice Montbriand, and I did a sleep study on selected cases of chronic pain and found a high incidence of sleep apnea. In Fibromylagia, disordered breathing (a dumbed down version of sleep apnea),is very common. Though the CPAP machine at night might help, tolerance to this mask-machine can be poor (1/5 FM subjects will tolerate). There are some measure that are helpful.
Here is a list I am working on:
1) Lose 10%+ of your weight- this can convert milder forms into nearly ok state:
JAMA. 2000 Dec 20;284(23):3015-21.
Longitudinal study of moderate weight change and sleep-disordered breathing.
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. abstract here free full text
an increase of 10% weight can increase chance of moderate sleep apnea by 6 fold
In case of obesity, bariatric surgery can have a huge impact on Fibromyalgia rates – reducing it by 92%:
Int J Obes (Lond). 2007 Jan;31(1):114-20. Epub 2006 Apr 25.
Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery.
Hooper MM, Stellato TA, Hallowell PT, Seitz BA, Moskowitz RW. abstract here
http://www.ncbi.nlm.nih.gov/pubmed/16652131
- average weight loss was 41 kg
- FM rates reduced 92% (small sample though)
- In Regina, there is a bariatric clinic:
http://www.rqhealth.ca/programs/surgical_care/bariatric_surgery.shtml
2) A Sleep apnea shirt
Sleep apnea is always much worse if one is on one’s back and there are shirts with Tennis ball like accessories in pockets in the back of the shirt that can prevent back sleeping.
Anesthesiology: October 2002 – Volume 97 – Issue 4 – pp 780-785
Lateral Position Decreases Collapsibility of the Passive Pharynx in Patients with Obstructive Sleep Apnea
Isono, Shiroh M.D.*; Tanaka, Atsuko M.D.*; Nishino, Takashi M.D. abstract here
Some versions have a cylinder pillow in the back:
3) A simple chin strap can even work in severe sleep apnea:
J Clin Sleep Med. 2007 Dec 15;3(7):729-30.
Treatment of severe obstructive sleep apnea syndrome with a chinstrap.
Vorona RD, Ware JC, Sinacori JT, Ford ML 3rd, Cross JP. free article here
There are chin straps that promise to draw the jaw forward and there was a patent on such a device: here
a href=”http://painmuse.org/wp-content/uploads/strap1.jpg”>
There are chinstraps that promise to improve snoring and by extension could help sleep apnea:
They want &119 – a similar chinstrap for $19 would be from amazon:
Ruby Adjustable Chin Strap
I wrote the first company and asked “what gives?” when it came to the difference in pricing and never got an answer.
3) Restricting Opioids – opioids at night will increase sleep apnea rates
4) Deal with edema – edema in legs during day will gravitate to throat at night and increase apnea rates –
American Journal of Respiratory and Critical Care Medicine Vol 179. pp. 241-246, (2009)
Relationship between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Nonobese Men
Stefania Redolfi1,2, Dai Yumino1,2, Pimon Ruttanaumpawan1,2, Brian Yau1,2, Mao-Chang Su1,2, Jennifer Lam1,2 and T. Douglas Bradley abstract here
- prolonged sitting is thought to be the main problem – perhap support hose during day might help
5) Deal with chronic rhinitis (chronic stuffy nose)
- chronic rhinitis subjects at an allergy clinic had Fibromyalgia:
Allergy Proc. 1992 Sep-Oct;13(5):263-7.
Chronic rhinitis: an underrecognized association with fibromyalgia.
Cleveland CH Jr et al - don’t smoke
- Steroid Nasal sprays could be helpful – some cases cannot tolerate the chemical in sprays but Rhinocort turbuhaler is a powder as per here
- Nasal dilator strip therapy
Sleep and Breathing Volume 10, Number 1, 16-28, DOI: 10.1007/s11325-005-0037-7
Nasal dilator strip therapy for chronic sleep-maintenance insomnia and symptoms of sleep-disordered breathing: a randomized controlled trial
Barry Krakow, Dominic Melendrez, Brandy Sisley, Teddy D. Warner, Jessica Krakow, Lisa Leahigh and Sam Lee abstract here
– found large improvements in Insomnia Severity Index
6) Intraoral jaw protruding splints
- In frank sleep apnea quite beneficial
Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea A Randomized, Controlled Trial
Helen Gotsopoulos et al.
Am J Respir Crit Care Med. Vol 166 pp 743–748, 2002 abstract http://www.atsjournals.org/doi/pdf/10.1164/rccm.200203-208OC - 81% achieve moderate- very refreshed sleep:
- My dentist uses myerson EMA oral appliance
Site can be accessed here:
http://myersontooth.com/products/ema-first-step.php
- Some dentists will “hose” their patients for them – should not cost more than few hundred dollars
- Dumbed down versions of this are used to treat snoring:
– Snore Guard seen here
– lots others – any suggestions?
Comments – some of these are not well tested out and could use other peoples perspectives